Friday, October 30, 2009

Laparoscopy using Ultrapulse Laser for Endometriosis and Pelvic Adhesions

Laparoscopy with Ultrapulse Laser for Endometriosis and Pelvic Adhesions

The Ultrapulse CO2 laser is the best surgical instrument for the treatment of endometriosis since it can vaporize undesired tissue (such as endometriosis or pelvic adhesions) without producing char (carbonization that results from charring or searing tissue with heat), with minimal risk of lateral thermal damage, and with little drying (desiccation) of treated tissue. Char, thermal damage (burn injury), desiccation of tissues, and damage to surrounding normal tissues will result in poor tissue healing, scar (adhesion) formation, increased inflammation with greater postoperative pain, and destruction of normal tissue that surrounds the tissue being treated.

The Ultrapulse CO2 laser is the gold standard surgical instrument used by Plastic Surgeons for the removal of skin scars (including burn scars), wrinkles, and damaged skin since it provides the best cosmetic results and postoperative skin tone. For more information on this laser see their website at http://www.aesthetic.lumenis.com/wt/page/ultrapulse.

The Ultrapulse CO2 laser has also been used for about 20 years for the treatment of pelvic endometriosis and pelvic scar tissue (adhesions) by many of the most experienced laparoscopic surgeons since the postoperative results following pelvic repair are similarly remarkable.

Many Reproductive Endocrinologists, including us, stress that endometriosis lesions must be removed in their entirety for longterm benefit.

Some of these surgeons claim that the lesions must be excised with scissors or other cutting instruments to insure that the base of the lesions are completely removed. The Ultrapulse CO2 laser is fully able to ablate abnormal tissue regardless of its depth or size with minimal lateral tissue damage. Manual excision with cutting instruments always damages underlying normal tissue since some of this normal tissue is removed along with the endometriosis lesion and the remaining tissue within the pelvis will have bleeding that must be controlled with cautery. Cauterization of bleeding vessels is designed to burn the bleeding vessels to form char, that then further damages the normal tissues surrounding the sites of excision and increases postoperative adhesion formation.

Other reproductive surgeons use instruments that are not as “delicate” for the surrounding tissues, including but not limited to the harmonic scalpel, monopolar or bipolar cautery devices, CO2 lasers with either continuous or superpulse waves (that cannot provide the same degree of safety and protection from lateral thermal damage when compared to the Ultrapulse CO2 laser), other non-CO2 lasers such as KTP or YAG lasers, and mechanical devices like scissors or cutting instruments.

The Ultrapulse CO2 laser is not available at most operating rooms, seemingly for a variety of reasons. The laser is extremely expensive and must be maintained properly so hospitals are very reluctant to purchase it. The laser requires significant time and experience by the surgeon in order to feel comfortable. Surgeons are often creatures of habit, so that when the surgeon becomes comfortable with a particular surgical tool it is inherently difficult to switch to a different surgical instrument.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has been using the Ultrapulse CO2 laser routinely since the early 1990s and has extensive laparoscopic experience over thousands of surgical cases treating endometriosis. Results in terms of reduction of pelvic pain and improved fertility have often been remarkable. For more information, consider a consultation with Dr. Daiter at 908 226 0250 or visit us on the web at http://www.drericdaitermd.comhttp://www.infertilitytutorials.com or http://www.ericdaiter.com

Monday, October 26, 2009

Laparoscopy for Pelvic Adhesions

Laparoscopy for Pelvic Adhesions

Pelvic adhesions (scars) develop as a normal tissue response to inflammation, which occurs whenever the tissue is damaged. Infertility surgeons make every attempt to limit or prevent pelvic adhesion formation following laparoscopy or laparotomy, and an experienced fertility surgeon may be able to significantly reduce the bulk of previously formed pelvic adhesions through meticulous care at laparoscopy.

Ideally, infertility surgery adheres to the principles of “microsurgical technique,” a set of surgical methods designed to reduce adhesion formation. Crush injuries to tissue can result in scar formation, so very gentle tissue handling is encouraged. Blood is very irritating to the lining cells overlying the pelvis, called peritoneum, so thorough control of even small amounts of bleeding and removal of any blood collected in the pelvis and abdomen is important. Identification of the proper tissue planes is important in order to avoid surgical damage to the tissues that are being separated so magnification should be available when needed. Tissues that dry out become damaged much more easily than tissues that are kept moist, and it is much easier to maintain adequate tissue moisture during laparoscopy as compared to laparotomy since the abdomen is essentially closed during the laparoscopy procedure. Infection should be avoided (and if inevitable then infection should be treated as early as possible) since a pelvic infection can rapidly destroy the very delicate reproductive tissues. Carbon deposits or char caused by the use (or overuse) of cautery to burn or sear abnormal tissues or control bleeding can result in adhesion formation and should be minimized whenever appropriate. Devascularization of tissue or ischemia can result from burn injuries that damage the blood vessels feeding tissues, so use of the ultrapulse CO2 laser is ideal for many infertility laparoscopy procedures since this tool allows vaporization of unwanted tissue with minimal lateral thermal damage to surrounding tissues.

Sunday, October 25, 2009

Ovulation and Trying to Get Pregnant

Ovulation and Trying to Get Pregnant

When trying to get pregnant, a couple ideally should have frequent intercourse (hopefully increasing the chances of exposing the egg to active sperm) just before and around the time that the egg is released from the ovary (ovulation). Trying to get pregnant, rather than simply finding out that you are pregnant “by accident,” can seem unnatural for some couples and this can add stress to a relationship. Initially, keeping things as natural as possible may be beneficial, since stress is rarely helpful.

Ovulation generally occurs about 14 days (2 weeks) prior to the onset of the next menstrual flow. If the menstrual cycle intervals are normally 28-30 days, then ovulation usually will occur around cycle day 14-16. If the menstrual cycle intervals are every 60 days (2 months), then ovulation usually will occur around cycle day 46. If the menstrual cycle intervals are very irregular, then detecting when ovulation is occurring using tests like ovulation predictor kits, serial blood work, or serial ultrasound exams can be helpful.

If ovulation is rare or extremely irregular, then fertility medication may be helpful in inducing or enhancing ovulation. An infertility doctor should be considered when fertility medications are being selected and administered.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC is board certified in Reproductive Endocrinology and Infertility and he has extensive experience with ovulation problems and menstrual irregularities. Dr. Daiter would be happy to help. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Please visit us on the web at http://www.drericdaitermd.comhttp://infertilitytutorials.com and http://www.ericdaiter.com

Friday, October 23, 2009

Ovulation and The Menstrual Cycle

Ovulation and the Menstrual Cycle

The onset of menstrual flow (menses) generally marks the beginning of the female reproductive cycle, during which an egg is matured and the uterine lining (endometrium) develops, to allow for embryo implantation and the development of a normal pregnancy. If no pregnancy occurs, then the endometrial lining is shed (the menstrual flow begins) and the cycle begins once again. Normally, menstrual cycle intervals are about every 28-30 days. Many fertile women have somewhat longer or shorter menstrual cycle intervals, suggesting that the egg quality at full maturity is somewhat independent of the time taken for the egg to develop fully.

The initial part of the menstrual cycle is often thought of as the “egg development” phase, and since the eggs develop within ovarian cysts called follicles this is usually referred to as the “follicular phase.” Ovulation normally occurs once a mature egg is developed. The final part of the menstrual cycle is the “luteal phase” marked by elevated progesterone production. The progesterone appears to modify the endometrium within the uterine cavity to allow for a 4-5 day “window of uterine receptivity” for embryo implantation, and if no pregnancy develops then the entire lining is shed about 14 days after ovulation. If a pregnancy does develop, then progesterone production normally remains elevated throughout the course of the pregnancy.

There are some problems with ovulation that can reduce fertility. Hormone imbalances involving thyroid hormone or prolactin can interfere with ovulation. If the egg is released from a follicle that has a smaller diameter than usual, then a relative progesterone deficiency may develop during the luteal phase of the cycle (luteal phase defect). Also, genetic or inherent problems with the egg can impact fertility.

Thursday, October 22, 2009

Ovulation Detection

Ovulation Detection

Normally, a reproductive age woman will have regular menstrual cycle intervals every 28-30 x 4-5 days. Prior to the onset of the menstrual flow, premenstrual symptoms are common (including breast tenderness, headaches, abdominal bloating, and mood swings), which generally reflect the cycle’s normal changes in reproductive hormones. A history of regular menstrual cycle intervals with premenstrual symptoms is fairly strong clinical evidence that ovulation is occurring monthly.

Ovulation normally occurs about 14 days (2 weeks) prior to the onset of the next menstrual flow. In women with very regular menstrual cycle intervals, counting back 14 days from the expected next menstrual flow provides a rough estimate of the date of ovulation.

Ovulation tests include ovulation predictor kits that use test strips that are dipped in urine daily, which cause a chemical reaction that changes the color of the patient’s test result when LH is present. When a mature egg has been developed within the ovary, the body signals the ovary to get the egg ready for fertilization and to release the egg (ovulate) with a surge in the hormone LH. When the patient’s concentration of LH is great enough to suggest the LH surge (trigger to ovulate) then the patient’s test line on the test strip is often equal or darker than the test strip’s reference line. Since the egg normally will ovulate about 36 hours (one and a half days) after the onset of the LH surge, once the test strip is initially positive for the LH surge then ovulation can be expected within a day or so. These test strips are usually accurate for women, but sometimes they don’t seem to be reliable for (work effectively for) a particular woman.

Ultrasound examinations of the ovaries can determine the size of follicles (ovarian cysts that contain an egg) and serial ultrasound exams during the follicular phase of the menstrual cycle (egg development phase) can usually determine with high accuracy when a mature egg has developed. Once the egg is mature, ovulation can be triggered by administering the hormone hCG (human chorionic gonadotropin), which acts exactly like the LH surge to trigger ovulation. In this way, the timing of ovulation can generally be predicted accurately within a few hours.

Tuesday, October 20, 2009

Ovulation and Infertility

Ovulation and Infertility

Successful human reproduction normally requires the coordination of several different events, including ovulation (release of a mature fertilization capable egg from the woman’s ovary), sperm production and release (ejaculation of mature motile sperm within seminal fluid), fertilization of the egg in the fallopian tube (sperm moves through the uterine cervix and uterine cavity into the tubes), and implantation of the developing pre-implantation embryo inside the uterine cavity.

Normally, a reproductive age woman will produce one mature egg per month, which is released from the ovary during ovulation. The eggs mature in ovarian cysts called follicles and during the “follicular phase” (egg developing phase) of the menstrual cycle the hormone FSH (follicle stimulating hormone) has a primary role in stimulating the maturation of eggs. Once the egg is developed, then the hormone LH surges to trigger the release of the egg at ovulation. After ovulation, there is an increase in the ovarian production of the hormone progesterone, which modifies and enhances the endometrial lining in preparation for embryo implantation.

Many abnormalities of the menstrual cycle and ovulation can occur and any of these problems will generally reduce fertility or cause infertility. A Reproductive Endocrinologist can suggest a diagnostic evaluation and infertility treatments based on the findings of the diagnostic tests.

Dr. Eric Daiter at The NJ Center for Fertility and Reproductive Medicine, LLC has extensive experience with all types of ovulation problems and menstrual irregularities. Dr. Daiter would be happy to help you to determine the cause of an ovulation problem and suggest treatment options. For an appointment to discuss your situation with Dr. Daiter, please call the office at 908 226 0250. Please visit us on the web at http://www.drericdaitermd.comhttp://infertilitytutorials.com and http://www.ericdaiter.com

Monday, October 19, 2009

semen analysis cost

Semen Analysis Cost (2009)

The semen analysis is a basic diagnostic test for male infertility that can determine whether the sperm that is produced within the semen (at ejaculation) has a normal appearance. Sometimes, the semen analysis is proposed as a “sperm function” test, such as when “strict morphology” is performed, but the reliability of a semen analysis to determine the ability of the sperm to fertilize an egg (it’s function) is low (it is unable to accurately predict function).

A semen analysis is a valuable and a relatively inexpensive fertility test. In our offices a basic semen analysis costs 100 dollars and determines the volume (of the total ejaculate), concentration (number of sperm per mL ejaculate), motility (percentage of the total sperm that are moving), and morphology (shape of the sperm) of the sperm. With this information, our Board Certified Reproductive Endocrinologist will be able to consult with you to further discuss useful diagnostic tests and infertility treatments. If a mild to moderate male infertility problem is suggested, starting infertility treatment with natural cycles and intrauterine insemination (IUI) is usually considered. If these are ineffective, more aggressive management is then considered.

About Me

Name: Dr. Eric Daiter

Location: United States

Dr. Daiter graduated medical school at Temple University Medical School in Philadelphia and completed the Obstetrics and Gynecology residency program at Albert Einstein College of Medicine in New York. He completed his Reproductive Endocrinology and Infertility fellowship at the Hospital of the University of Pennsylvania. He has considered a career as a physician scientist in research medicine and has published several articles on molecular events that occur during the human embryo's implantation into the uterus.